Lower urinary tract symptoms (LUTS) in men are a rising problem as more men age. For a urological evaluation of LUTS in men, the International Prostate Symptom Score (IPSS) is the most commonly used questionnaire worldwide. The IPSS is intended to convert subjective symptoms into quantitative values, with four questions referring to storage symptoms and the other three questions to irritative symptoms. One question is added regarding the Quality of Life (QoL). The IPSS-scores are used for diagnosis, treatment choices and evaluation of therapy results.
However, several studies have shown problems with the completion of the IPSS. Self-completion results in an incomplete questionnaire in 53-73% of men and, especially when men have a lower level of education, poor correctness of symptom representation.
A partner or even another family member can provide an inexpensive and uncomplicated solution for help in completing the questionnaire. Though, the question arises what can be done when the patient is entirely unable to complete the IPSS, even with help. This study investigates the reliability of IPSS of men with LUTS filled out the ones closest to them: their partners.

A power of 34 was calculated, after which 43 couples were included. Men (over 50) attending the urology outpatient clinic were asked to participate. After approval, the man and the partner were asked to separately fill out the IPSS for complaints of the man. If the man came alone to his appointment, after approval, the partner (relationship > 1 year, at least 3 nights a week together) was called to complete the questions by phone. Individual questions, total scores and subscores (obstructive and irritant) were compared. For statistics, Pearson and Spearman correlation, Bland-Altman plotting and Kappa were calculated.

Firstly, a Pearson and Spearman correlation between patients total score and partners total score proved 0.62 and 0.61 respectively. Bland- Altman plotting showed substantial spread, and Kappa was 0.162 (slight). As men had higher scores, partners tended to score higher as well. As shown in the Table, 20 couples (46.5%) score the patient's symptoms in the same severity category (mild (n=5), moderate (n=23) and severe (n=15)), 22 couples (51.2%) differed one category and one couple (2.3%) differed two categories. Partners slightly ended to overscore and therefore seemed only moderately able to assess true symptom severity.
Even for QoL, partners proved only modestly reliable (kappa 0.192). 
The irritative subscore proved slightly better assessed then the storage subscore, mainly because the question on nocturia, showing fair correlation with kappa being 0.367.

For the first time, a study was performed in which the IPSS scores of male LUTS were completed by their partners. They were found to be only modestly able to reliably replace their husbands. One had to take into account that the sudden request to partners to fill out the form does not conform to the reality where the questionnaire is sent in advance; the partner's result in that situation may be better than the result tested in our study. If the IPSS is not sufficiently understood, another instrument could possibly be used, as shown in previous research.

In this first study using IPSS as a measure to assess male LUTS, female partners proved only modestly able to reliably substitute their spous. With an increase in men depending on carers, especially ones not as closes as spouses tested in this study, a trustworthy alternative assessment of symptoms by another than patients themselves is desirable.